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To the Editor:

Last year, Academic Medicine published an article by Amin and colleagues1 on the relevance of the Flexner Report to contemporary medical education in South Asia. This article is timely, pertinent, and appropriate for most South Asian countries. However, we wish to emphasize the exceptional nature of medical education in at least one South Asian country, Sri Lanka, which has implemented the recommendations of the Flexner Report to a far greater extent than have other South Asian countries.

All of Sri Lanka's medical schools are free and government funded. In all other South Asian countries, there are both private and public medical schools, with private schools outnumbering the government ones in some countries. Of the eight medical schools in Sri Lanka, five are outside the main city. Student selection to attend all these medical schools is through a central examination. The final examination for senior medical students is standardized to an extent by a common, multiple-choice questionnaire used in a few of the medical schools for each subject. All medical schools are a part of a national university system, and quality is controlled by the Sri Lanka Medical Council. For academics to be confirmed in their academic positions, they must meet specified criteria within a given time period. All medical schools not only teach the clinical side of medicine but also teach professionalism and humanism in medicine and have a medical education unit to support teaching, learning, assessment, and faculty development.

All medical schools are attached to one or more government hospitals, called teaching hospitals, that house clinical teaching units staffed by medical school faculty. Additionally, extended faculty, who are employees of the government health ministry, are involved in clinical teaching.

Some of these elements of medical education in Sri Lanka have been established for many decades. We think Sri Lanka can be considered a country that implemented Flexner's recommendations a long time ago and then developed further, parallel to the continuing development of medical education elsewhere in the world.2

That said, there is ample room for improvement in Sri Lanka's medical education system, especially regarding the need for more robust assessment practices and selection policies. Regarding private medical education, Sri Lanka is at the threshold of a boom, and many of the concerns that Amin and colleagues raised in this regard will hold true if tight regulation is not in place.

Notwithstanding the above concerns, Sri Lanka has higher health indicators than all other South Asian countries; these indicators are even comparable with those of developed countries. We believe that the exceptional quality of Sri Lanka's medical education has contributed to these achievements.3